What changes in health-related quality of life matter to multiple myeloma patients? A prospective study

Ann K. Kvam, Peter Fayers, Finn Wisloff

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39 Citations (Scopus)


Objective: To determine the clinical significance of changes in quality-of-life scores in patients with multiple myeloma (MM), we have estimated the minimal important difference (MID) for the health-related quality-of-life instrument, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. The MID is the smallest change in a quality-of-life score considered important to patients. Methods: Between 2006 and 2008, 239 patients with MM completed the EORTC QLQ-C30 at inclusion (T1) and after 3 months (T2). At T2, a structured quality-of-life interview was also performed. MIDs were calculated by using mean score changes (T2-T1) for patients who in the interview stated they had improved, deteriorated or were unchanged. MIDs were also estimated by the receiver-operating characteristic (ROC) curve method as well as by calculation effect sizes using standard deviations of baseline scores. Results: MIDs varied slightly depending on the method used. Patients stating in the interview that they had 'improved' or 'deteriorated' had a corresponding change in EORTC QLQ-C30 score ranging from 6 to 15 (improvement) and from 9 to 17 (deterioration) (scale range 0-100). The ROC analysis indicated that changes in score from 7 to 17 represent clinically important changes to patients. The effect size method suggested 5-6 to be a small and 11-15 to be a medium change. Conclusion: Calculation of MIDs as mean score changes or by ROC analysis suggested that a change in the EORTC QLQ-C30 score in the range of approximately 6-17 is considered important by patients with MM. These MIDs are closer to a medium effect size than to a small effect size. Our findings imply that mean score changes smaller than 6 are unlikely to be important to the patients, even if these changes are statistically significant.

Original languageEnglish
Pages (from-to)345-353
Number of pages9
JournalEuropean Journal of Haematology
Issue number4
Early online date22 Dec 2009
Publication statusPublished - Apr 2010


  • quality of life
  • multiple myeloma
  • minimal important difference
  • clinically important difference
  • meaningful change
  • scores
  • questionnaire
  • responsiveness
  • outcomes
  • therapy
  • quality of life
  • multiple myeloma
  • minimal important difference

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